Approximately 5% (estimates range from under 4% to nearly 11%) of newborn human children suffer from ankyloglossia, or “tongue-tie,” a condition in which the lingual frenulum (a small fold of mucous membrane extending from the floor of the mouth to the midline of the underside of the tongue) is too short, restricting normal movement and function of the tongue. A neonate may be considered to suffer from tongue-tie when the tongue tip is unable to protrude beyond the incisors. However, the degree of restriction, and the severity of the resulting effects, vary from patient to patient. There is no sharp threshold.
Tongue-tie is linked to poor latching/sucking with breastfeeding, which leads to decreases in emptying of the breast as well as in milk transfer. These effects ultimately slow the baby's weight gain. Instead of moving the tongue out of the mouth to “milk” the breast, the neonate is chewing and cupping the nipple tip in an attempt to maintain nipple position. Subsequent damage to the nipple tip may follow with severe pain. The persistence of severe tongue-tie beyond the neonatal period may cause problems with articulation (though usually without speech delay), dental health, social/aesthetic effects (appearance, eating, kissing, playing wind musical instruments, etc.).
The condition can in principle be easily treated by snipping or clipping the restrictive frenulum, an operation known as frenotomy or frenulotomy. Usually, no suture is needed. However, injury to nearby structures (lateral genioglossus muscle and vessels, cheeks, lips, submandibular salivary gland ducts) is to be avoided. Potential adverse outcomes include bleeding, infection, ulceration, pain, cheloid scarring, and recurrence.
It is desirable to use only a topical or local anesthetic, to avoid the complications of more extensive anesthesia. It is therefore necessary to hold the tongue up out of the way with fingers or a depressor, while snipping the frenulum. When treating an alert baby in an outpatient office or doctor's office, it is not always easy to snip the frenulum accurately and cleanly, especially as the baby's small mouth does not allow room for multiple persons to assist, even if additional personnel are available. There is therefore a need for an improved method and apparatus.